Silent treatment: Why docs don't snitch when colleagues make mistakes

A new report in the New England Journal of Medicine may shed light on some of the reasons hospital medical errors are the third leading cause of death in the nation: Doctors won't tell patients when other clinicians make medical mistakes.

Although there is guidance on how a physician who commits the error should disclose the information to the patient and family members, there are no such guidelines for doctors who discover a colleague's mistake.

Lack of first-hand knowledge about the case, litigation concerns and fear of how a colleague--especially someone who has a higher position or seniority--reacts, are just some physician barriers, according to the report, "Talking with Patients about Other Clinicians' Errors."

Lead researcher Thomas H. Gallagher, M.D., an internist and professor at the University of Washington School of Medicine, told ProPublica that physicians experience a range of emotions when they discover a colleague's error. They may wonder whether they should keep the information to themselves or tell someone, think about what they would want a colleague to do if the situation was reversed or worry about the repercussions if they disclose the error. The result, he said in the article, is leniency toward mistakes.

The NEJM report suggests that despite physicians' worry they may damage their relationship with colleagues, they must remember the patient has a right to know and it's their ethical responsibility to share the information.

"When faced with a potential error involving another health care worker, our conceptions of professionalism should lead us to turn toward, rather than away from, involved colleagues," the researchers concluded. "Although making the effort to understand what happened and ensure appropriate communication with the patient may challenge traditional norms of collegial behavior and involve additional demands on clinicians' time, transparent disclosure of errors is a shared professional responsibility."

Meanwhile, a separate study published in Circulation suggests that there is some truth to the "July effect"--the higher likelihood of patient death when medical students leave the classroom and enter patients' rooms in teaching hospitals.

Researchers at Harvard Medical School, Stanford University Hospitals, University of Southern California and the RAND Corporation, found that in July, the risk of death for high-risk patients who came to teaching hospitals after suffering heart attacks rose from 20 percent to 25 percent. In addition, the difference between patient outcomes in May and July is greatest within organizations that have the highest percentage of trainees.

"The good news for patients is that in most cases, it's very difficult for a physician to make a mistake that results in a patient's death, lead author Anupam Jena, M.D., Ph.D., assistant professor of healthcare policy and medicine at Harvard Medical School and an assistant physician and professor in the department of medicine at Massachusetts General Hospital, said in a the study announcement. "But for severely ill patients, health can be very tenuous. A small error or a very slight delay in care is potentially devastating."  

For more:
- read the NEJM report
- here's the ProPublica piece
- check out the Circulation study abstract
- read the study announcement